The present invention relates to the medical instrument arts. It finds particular application in conjunction with an improved combination needle holder and suture cutter medical instrument for use in closing an incision or wound, and will be described with particular reference thereto.
It is known to use separate needle driver and scissors instruments during a medical procedure to close an incision or wound. In particular, the needle driver is used to pass a needle and depending suture through incised tissue. Thereafter, the scissors are used to cut the suture after a finishing knot has been tied in the suture.
It is burdensome, time consuming, and overly-complicated to repeatedly alternate between two separate medical instruments when placing individual stitches. In the case where no medical assistant is available to hand the instruments to the surgeon (or other person performing the suturing procedure), the surgeon must repeatedly pick-up and put-down the instruments thus increasing the chance of dropping or placing an instrument outside a sterile field surrounding the incision or wound. These problems compound when numerous stitches are required to close a relatively large incision or wound.
U.S. Pat. No. 2,315,326, issued to Gmeiner, discloses a combination needle holder and scissors instrument 10 that allows a surgeon to suture an incision or wound with a single instrument. As shown in FIG. 1, the Gmeiner instrument includes a pair of hingedly connected jaws 12a, 12b each having end teeth 14a, 14b for gripping a needle 16 (shown in cross-section) and a guide or stop block 18 therefore, together with a pair of longitudinally positioned shearing blades 20a, 20b between the stop block 18 and jaw pivot 22. The shearing blades 20a, 20b cooperate to shear or otherwise cut the suture in a scissors-like manner. The Gmeiner instrument also includes a pair of arms or handles 24a, 24b that have finger loops 26a, 26b and a lock mechanism 28a, 28b.
In operation, the jaws 12a, 12b of the Gmeiner instrument are clamped around a needle by bringing the loops 26a, 26b and depending handles 24a, 24b together to actuate the lock mechanism 28a, 28b in a known manner. Thereafter, the Gmeiner instrument is manipulated to pass the clamped needle and depending suture through the tissue. After a finishing knot has been placed in the suture, the jaws 12a, 12b of the Gmeiner instrument are unclamped from around the needle by deactuating the lock mechanism 28a, 28b to separate the handles 24a, 24b in a conventional manner. With the jaws (and handles) of the Gmeiner instrument open, the shearing blades 20a, 20b are positioned proximate the finishing knot and then actuated by bringing the handles 24a, 24b together to cut the suture in a scissors-like manner. It should be appreciated that the lock mechanism may be inadvertently actuated when bringing the handles together to sever the suture.
Thus, a disadvantage associated with the Gmeiner instrument is that the jaws must close in order to effectuate the scissors-like cutting of the suture. This not only involves properly positioning the shearing blades close to the finishing knot, but it also involves separately manipulating (i.e. closing the handles) the instrument to effectuate the cutting action. Two specific problems arise from this operation. First, as mentioned, the lock mechanism may be inadvertently actuated while cutting the suture. This locks the handles together, thus requiring the instrument to be unlocked before it can be used again to reclamp the same needle and remaining suture, or to clamp to a new needle and suture. The unlocking motion is an extra operation that disadvantageously increases the amount of time to complete the procedure and the amount of effort required to perform the procedure.
Second, the use of two shearing blades (or one die cut blade and a guide surface) requires relatively exact alignment of the instrument to the suture, i.e., perpendicular placement of the device relative to the finishing knot. Due to space constraints and/or the angle and area of the suture involved, this alignment may be difficult, thus hampering the cutting operation.
Accordingly, it has been considered desirable to develop a new and improved combination needle holder and suture cutter medical instrument for use in closing an incision or wound which meets the above-stated needs and overcomes the foregoing difficulties and others while providing better and more advantageous results.